Steroid-refractory hand eczema: treatment experience

Hand eczema is a common multi-etiological disease manifested by evolutionary polymorphism of rashes. Hand eczema develops against the background of altered reactivity and genetic predisposition under the adverse effects of endogenous and exogenous factors. Hand eczema has a chronic course and is characterized by a wide range of clinical manifestations. The prevalence of eczematous lesions of the hands among the adult population is 1–2%, and among all skin diseases – 30–40%. The disease has an extremely negative impact on the quality of life, ability to work, career prospects and the social status of a person. The long course of eczematous lesions of the hands can be complicated by a secondary infection: bacterial and mycotic flora. Therefore, choosing the right and effective treatment for hand eczema is a particularly difficult task for a dermatologist. In recent years, a multicomponent drug based on gentamicin sulfate, dexpanthenol, mometasone furoate and econazole nitrate has been widely used for the treatment of hand eczema due to its high efficacy, tolerability, and safety. The use of this multicomponent drug in monotherapy for hand eczema is effective, leads to clinical remission and restoration of the quality of life of patients and is not accompanied by side effects and complications. This review focuses on the epidemiology, clinical features, and treatment options for hand eczema. Clinical experience with the use of a multicomponent drug in patients with hand eczema complicated by infection is also given

MODERN APPROACH TO DIAGNOSTICS, PREVENTION AND CORRECTION OF ACNE SCARRING ON THE BASIS OF STUDY OF SKIN MORPHOLOGY BY NONINVASIVE METHODS

The efficacy of the long-acting drug of hyaluronidase (bovhyaluronidase azoximer, BHA) in acne and postacne patients has been studied. The main criteria for the efficacy of acne and post-acne therapy in the assessment by confocal laser scanning microscopy and laser Doppler flowmetry are proposed.Materials and methods. Randomized, double-blind, placebo-controlled study, comparative in parallel groups. 90 patients aged 18 to 35 years (23.76 ± 4.59 years) with medium and severe acne and postacne were divided into 2 groups of 45 each by randomization (the first group received BHA 3000ME, the second — a placebo). There were two methods of administration of drug or placebo: intramuscular injection or ultraphoonophoresis. Evaluation of the skin was performed by confocal laser scanning microscopy (CLSM) in vivo (VivaScope®, NY, USA), microcirculation — by the laser Doppler flowmetry (LDF) with the laser capillary blood flow analyzer (LAKK-01, Russia). The effectiveness was evaluated by the Qualitative scaring grading system and Goodman’s quantitative global acne scarring system.Results and conclusions: With the use of BHA 80 % of patients had an improvement, 8.89 % — a significant improvement, postoperative index was reduced from 14.27 ± 5.61 to 10.18 ± 4.63 points (p < 0.05). In the placebo group the reduction of indices is insignificant. The effectiveness of the use of BHA by the ultraphonophoresis was lower than by intramuscular injection. A significant change in the microcirculation index (flux) was established from 20.09 ± 1.74 PU (Perfusion Units) up to 15.2 ± 2,1 PU (p = 0,01). The normalization of the microcirculation was noted. According to the results of CLSM, among BHA patients were observed a significant decrease of severe fibrosis and inflammatory infiltration, the number of dilated vessels. In the placebo group signs persisted. Clinical and morphological monitoring showed the expediency, high efficiency and safety of BHA in the therapy of patients with medium and severe acne vulgaris and postacne

Dermatological morbidity of the rural areas' population of the Republic of Uzbekistan under the conditions of use of mineral fertilizers

Introduction. Exogenous, in particular, environmental factors are among the most significant factors affecting the course of a number of dermatoses. A study of the effect of chemical use in agriculture on dermatological morbidity was conducted.Objective. To assess the features of dermatological morbidity in rural areas, depending on the load of mineral fertilizers per hectare of arable land and per capita.Materials and methods. The object of the study was persons aged 18 to 68 years living in two rural areas of the Tashkent region: Chinaz district - cotton sowing; Bostanlyk district - horticultural. Our research was used materials of statistical reporting on the volume of mineral fertilizers used, conducted screening testing, clinical examination and history taking.Results. The incidence of dermatological diseases was 2,5 times higher in the cotton growing area compared with the horticultural region (94,1 versus 38,2, p < 0,001). A comparative analysis of clinical manifestations in persons with dermatological diseases of two rural areas showed a higher degree of activity of the skin pathological process in the cotton growing area especially among people with diffuse and complicated variants of atopic dermatitis.Conclusion. Allergic diseases predominate in the structure of skin pathology in the examined areas of the Tashkent region. In a cotton-growing area, the manifestations of allergic dermatitis are characterized by a more severe course and frequent relapses. The results of the study show that both the dermatological service and the agricultural chemical management system of the Republic need to apply best practices to improve quality and to ameliorate problems

Experience in managing psoriasis patients receiving targeted therapy during the COVID-19 pandemic

Introduction. With the onset of the COVID-19 pandemic the dermatological manifestations of the infection are widely discussed along with the correct management tactics for patients with severe chronic dermatoses, primarily those on immunosuppressive therapy. Immunocompromised patients are overly vulnerable to infections, which is especially important in the context of the pandemic. The article provides up-to-date literature information regarding the general risks of infection in patients receiving systemic immunomodulatory agents for the treatment of psoriasis, as well as evidence based treatment recommendations, including the example of our own clinical experience of using targeted therapy during the COVID-19 pandemic.Purpose of the study. The aim of the study was to analyze the therapeutic efficacy and safety of the systemic immunomodulatory drugs therapy in the context of the global COVID-19 pandemic.Materials and methods. The study included 142 patients with psoriasis receiving GEBD and small molecules therapy at the Department of Anti-Cytokine Therapy and Efferent Methods of Treatment of MNPCDK DZM. All patients were examined to determine their level of IgM and IgG antibodies to the SARS-CoV-2 virus strain in the blood serum. All patients continued to receive therapy according to their individual dosing regimen. The study was conducted at a time of high morbidity in the city of Moscow.Results. The overall morbidity among the studied patients was 13.4% of which the majority were patients with an asymptomatic course of the disease. It should be noted that there was a low incidence rate among patients receiving therapy with IL-17 inhibitors (secukinumab, netakimab).Conclusion. Our study confirms worldwide records that there is no evidence of an increased risk of COVID-19 among patients receiving targeted therapy for psoriasis. In our opinion, the discuntinuation of the current treatment can lead to unjustified risks, such as a relapse of psoriasis, including with severe manifestations and subsequent possible ineffectiveness when resuming therapy.Potentially, the termination of therapy that suppresses the production of proinflammatory cytokines will lead to an increase in the “cytokine storm” and a worsening of the course of viral infection when it occurs

New possibilities of systemic therapy of plaque psoriasis with the IL23p19 inhibitor risankizumab

Introduction. There is a trend towards rising incidence of psoriasis and increase in the degree of incidence of severe, atypical and treatment-resistant clinical forms of psoriasis in the Russian Federation. In this regard, cases of early disability of patients and deterioration of their quality of life are recorded, which determines the medical and social significance of this disease. In the last few years, a much deeper understanding of the pathogenesis of psoriasis has been gained. This is especially true of the role of T-helper 17 cells, the role of the IL-23 cytokine in the development of the disease, which has resulted in the development of new classes of biological drugs, which creation introduced significant changes in the treatment of psoriasis that has become more effective, safer and convenient for patients. More new biologics undergo clinical trials and receive approvals with each passing year. Among them is risankizumab, interleukin-23 inhibitor, which is a safe and effective drug for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis in adult patients. Interleukin-23 inhibitors are not required to be administered as often as interleukin-17 inhibitors and may have a more favourable safety profile without an increased risk of candidiasis or inflammatory bowel disease. Overall, these highly effective drugs contribute to the improvement of the long-term efficacy of psoriasis therapy due to relief of skin lesions and joint symptoms, as well as to the enhancement of patients’ quality of life and lengthening of remissions.Purpose. To analyse key information about risankizumab using the results of clinical trials published in the current scientific literature.Materials and methods. This analysis used literature sources from the international medical databases: PubMed, Cochrane Library, MEDLINE.Results. Presently, a number of phase III registrational trials of risankizumab in 2,109 patients with plaque psoriasis have been published: UltIMMa-1, UltIMMa-2, IMMvent and IMMhance, as well as an additional side by side comparative study of risankizumab with secukinumab (IMMerge) in 327 patients with plaque psoriasis. The results of these studies were used as the grounds for approval of risankizumab for the treatment of patients with moderate to severe plaque psoriasis and psoriatic arthritis by the Russian Ministry of Health on September 14, 2020. There have also been several reports of interim results of the open-label enhanced LIMMitless study, which included patients from pivotal studies. Our records show that the percentage of patients receiving risankizumab for 3 years (172 weeks) and maintaining PASI 90 and PASI 100 was 88 and 63%, respectively, and the percentage of those maintaining sPGA 0/1 was 88%.Conclusion. The analysed data showed that risankizumab is one of the most effective target drugs for the treatment of psoriasis and psoriatic arthritis, it has a favourable safety profile and a more convenient dosage regimen as compared with other genetically engineered biologic drugs (GEBD) (the recommended dose of Skyrizi is 150 mg (two 75 mg injections) administered by subcutaneous injection at week 0, week 4, and every 12 weeks thereafter)

Experience of applying a multi-component gel based on troxerutin, heparin sodium and dexpanthenol in the rehabilitation of patients after cosmetic procedures

The article reports an up-to-date classification of complications of cosmetic procedures and two clinical cases where multicomponent gel based on troxerutin, heparin sodium and depanthenol was used to rehabilitate patients after cosmetic procedures complicated by ecchymosis, hematomas and edema. In the first case a 30-year-old patient had a procedure to give greater volume to her lips and to correct their asymmetry with hyaluronic acid filler. The procedure was complicated by the formation of hematomas and edema. To minimize the edema and hematomas and to avoid the risk of infection the patient was prescribed 0.05% aqueous solution of chlorhexidine bi-gluconate once per day and taking of multicomponent gel based on troxerutin, heparin sodium and depanthenol two times per day for seven days. By the fifth day there was observed a significant decrease in edema of the lip area and almost complete resorption of hematomas. In the second case a 42-year-old patient had a procedure of a biorevitalization with unstabilized hyaluronic acid complicated by the appearance of ecchymosis up to 12 mm in diameter and edema in the periorbital zone. A 0.05% aqueous solution of chlorhexidine bi-gluconate once per day and a multicomponent gel based on troxerutin, heparin sodium and dexpanthenol twice per day for seven days were prescribed as post-procedural rehabilitation. By the fourth day clinical improvement was noted. The edema disappeared, the color changed, the size of the ecchymosis decreased to 4 mm. The ecchymosis disappeared completely on the sixth day. In addition, the main characteristics of troxerutin, heparin sodium and depanthenol as components of a multicomponent gel were considered. A multicomponent gel based on troxerutin, heparin sodium and depanthenol as supportive aid helped to get complications completely cleaned out and significantly reduced the rehabilitation period for these patients. The authors consider it possible to recommend it as a means of post-procedural rehabilitation

Management of patients at high risk of developing skin melanoma: organizational and clinical aspects

Early diagnosis of skin melanoma is one of the most reliable ways to improve the prognosis for the life of patients with this tumor. Organization of medical care for patients with a high risk of developing melanoma, together with the use of non-invasive diagnostic methods and teaching the patient the principles of prevention and early diagnosis of skin malignancies should improve the survival rates of patients with melanoma. The article discusses the experience of implementing the Organizational model of medical care for patients with skin neoplasms in Moscow, as well as the key rules for managing patients at risk of developing skin melanoma with special emphasis on recommendations to patients for regular self-examination of the skin, lifestyle correction and the use of photoprotective agents

Development of a quasi-chemical viscosity model for fully liquid slags in the Al2O3-CaO-'FeO'-MgO-SiO2 system. Part 3. Summary of the model predictions for the Al2O3-CaO-MgO-SiO2 system and its sub-systems

A structurally-based quasi-chemical viscosity model for fully liquid slags in the Al2O3 CaO-'FeO'-MgOSiO2 system has been developed. The focus of the work described in the present paper is the analysis of the experimental data and viscosity models in the quaternary system Al2O3 CaO-MgO-SiO2 and its subsystems. A review of the experimental data, viscometry methods used and viscosity models available in the Al2O3 CaO-MgO-SiO2 and its sub-systems is reported. The quasi-chemical viscosity model is shown to provide good agreement between experimental data and predictions over the whole compositional range